What Tests Can Be Used To Diagnose Chronic Dry Eye?

The complex nature of dry eye disease makes it more challenging to diagnose and treat. Fortunately, your eye doctor has different tests and exams that may be used to help diagnose dry eye disease.

Slit lamp examination

A slit lamp is a microscope with a bright light. Your doctor uses this to see the parts of your eye up close. This device is a key to finding eye disease and assessing the overall health of your eye.1

Schirmer test

This test measures the amount of tears you produce. Blotting strips of paper are placed under your lower eyelids. Your doctor then checks the amount of strip soaked by your tears after 5 minutes. A strip with less than 5 milliliters of wetting suggests decreased tear production.2

Fluorescein, lissamine green, and rose bengal staining

Diagnostic dyes help your doctor see if there is damaged tissue on the surface of your eye. Your doctor places eye drops containing the dye or paints your eye with test strips containing the dye. Your doctor will then use the slit lamp to see areas of damage on the surface of your eye.2-5

Phenol red thread test

For this test, a thread that is filled with dye is placed over your lower eyelid for 15 seconds. Your tears change the color of the dye, which then measures the volume of your tears. If the volume of your tears are less than normal, this may be the reason for your dry eyes.2

Corneal topography

Corneal topography is a non-invasive, painless procedure. It is used to take 3-D pictures of the surface of the clear outer layer of your eye (cornea). This is essentially “maps” the surface, showing your doctor areas that may be abnormal.6

OCULUS Keratograph 5M

The OCULUS Keratograph combines corneal topography and dry eye analysis in 1 machine. The device can also check for meibomian gland dysfunction (MGD) and tear film break-up time.7

Tear Stability Analysis System

The Tear Stability Analysis System (TSAS) captures an image of the corneal surface every second for 10 seconds. These images are then analyzed for tear breakup time and overall tear film stability. These results help to diagnose dry eye related to the stability of the tear film.8

LipiView Ocular Surface Interferometer

Studies have shown that decreases in the lipid layer (oily layer) of the tear film can lead to dry eye symptoms. Decreased oil in the tears is caused by meibomian gland dysfunction (MGD). This accounts for 85 to 90 percent of all chronic dry eye.9

The LipiView Ocular Surface Interferometer measures the thickness of the lipid layer of the tear film, provides images of the meibomian glands, and analyzes blink patterns. This painless device helps your doctor determine if dry eye symptoms are related to meibomian gland dysfunction or blinking problems.10

Point-of-care (POC) tests

Point-of-care (POC) tests are tests that are performed near or at the eye doctor. The results may possibly change the course of your care. An advantage of POC tests is the rapid results. In some cases, this makes diagnosis and adjustments in management quicker.11

RPS InflammaDry Detector™

The RPS InflammaDry Detector™ is a point-of-care test that detects MMP-9. This is an inflammatory marker that may be elevated in the tears of those with dry eye disease. Results are achieved in 10 minutes.12

The TearLab Osmolarity System

Osmolarity is the measure of particles in a solution. Hyperosmolarity of the tears means more salt or other particles and less water. This abnormal makeup of tears can lead to the development of dry eye.13

The TearLab Osmolarity System uses a handheld device that measures the tear osmolarity by sampling a microscopic amount of the tears. The results are measured immediately, allowing for rapid diagnosis.14

Blood tests

Various blood tests may be ordered by your eye doctor, depending on what may be causing your dry eye symptoms.

Sjögren’s syndrome is an autoimmune disorder that affects the moisture-producing glands of the body. Most commonly, Sjögren’s syndrome impacts the glands that produce tears (lacrimal glands) and saliva (salivary glands).15

One test, the Sjö™ panel, is a blood test that detects specific markers of Sjögren’s syndrome. Your doctor may order this panel if you have Sjögren’s syndrome or if your doctor suspects may you have it.16

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Written By: Katie Murphy│Last reviewed: June 2021